INTRODUCTION

First aid can be defined as the initial assistance or treatment given to someone who is injured or suddenly taken ill (St John Ambulance et al., 2011). It can cover a wide range of scenarios ranging from simple reassurance following a minor mishap to dealing with a life-threatening emergency (Jevon, 2004).

Providing first aid can be stressful; the stress of working in unfamiliar circumstances, sometimes with inquisitive and intrusive onlookers should not be underestimated. It is important to remain calm and focussed on the priorities.

The aim of this chapter is to provide an overview to the principles of first aid in the dental practice. Some aspects of first aid, e.g. CPR, will be discussed in other parts of this book.

PRIORITIES OF FIRST AID

The priorities of first aid are to:

• ensure appropriate help is called if necessary;
• ensure both the rescuer’s and casualty’s safety;
• keep the casualty alive: i.e. particular attention to airway, breathing and circulation;
• prevent the casualty from deteriorating;
• promote the recovery of the casualty;
• provide reassurance and comfort to the casualty.

Source: Jevon (2004)

RESPONSIBILITIES WHEN PROVIDING FIRST AID

The provision of first aid is not an exact science and it is important to remember the golden rule: ‘first do no harm’ while applying the term ‘calculated risk’ (St John Ambulance et al., 2011). The dental practitioner has a number of responsibilities if he is required to provide first aid.

• Assessing the situation quickly and safely;
• Ensuring appropriate help is summoned;
• Protecting the casualty and others at the scene from possible harm;
• Identifying as far as possible the cause of the illness or the nature of the injury;
• Providing first aid within her own sphere of expertise and competence;
• Ensuring that any first aid provided follows current and up-to-date guidelines, where appropriate;
• Minimising the risk of cross-infection;
• Reporting observations/findings to those taking over the care of the casualty;
• Adhering to the GDC’s Code of Conduct (2005);
• Maintaining the casualty’s confidentiality following the GDC’s guidelines;
• Obtaining the casualty’s consent (if possible) prior to administering first aid.

Source: Jevon (2004); St John Ambulance et al. (2011)

ASSESSMENT OF THE CASUALTY

Safe approach

The initial priority is always to ensure if it is safe to approach the casualty. This includes ensuring that measures are taken to minimise the risk of cross-infection.

Primary survey

The priority is then to assess the casualty following the ABCDE approach (see Chapter 3) to identify any life-threatening problems and provide emergency life-support treatment as required.

Secondary survey

Once it has been established that the casualty is not out of immediate danger, a secondary survey should be undertaken (St John Ambulance et al., 2011) and, depending on the situation, this could involve:

• taking a history;
• looking for external clues;
• ascertaining the mechanics of injury;
• assessing signs and symptoms;
• head-to-toe survey.

Source: Jevon (2004); St John Ambulance et al. (2011)

Definitive care

Depending on the scenario, definitive care could involve:

• providing advice only;
• advising the casualty to visit his GP;
• arranging transport to take the casualty to hospital;
• alerting the emergency services.

Source: Jevon (2004); St John Ambulance et al. (2011)

Environmental hazards that may be encountered

Environmental hazards that may be encountered in the dental practice include gas, electricity, fire and poisoning.

Gas

If there is a smell of gas or a gas leak is detected:

• Open doors and windows to disperse the gas;
• Check to see if the gas supply to an appliance has been left on, unlit or if the pilot light has gone out;
• Do not smoke, use matches or naked flames;
• Do not turn electrical switches on or off – this includes the door bell;
• Turn off the gas supply at the meter (unless it is located in a cellar);
• Contact National Grid Gas Emergencies on 0800 111 999 (24 hour line).

Source: National Grid (2013); Gas Guide (2013)

Low-voltage electricity

Injuries caused by electricity often occur in the workplace environment resulting from contact with a low-voltage domestic current, usually due to a faulty switch or appliance (St John Ambulance et al., 2011). The presence of water presents additional risks. The electrical contact will need to be broken.

Switch off the current at the mains or meter point if it can be easily reached; otherwise, remove the plug or wrench the cable free (St John Ambulance et al., 2011). If unable to reach the plug, cable or mains:

• Stand on some dry insulating material, e.g. telephone directory, wooden box.
• Using a wooden object, e.g. broom, push the casualty’s limbs away from the electrical source or push the latter away from the casualty. Do not use anything metallic.
• If the casualty still remains attached to the electrical current, carefully loop some rope around his ankles and pull him away from the source.

Source: Jevon (2004); St John Ambulance et al. (2011)

Fire

Dental practices should have an emergency plan (Box 14.1) in place in case of fire. This will be specific to the premises and will detail the pre-planned procedures in place for use in the event of a fire. This will typically involve:

• Raising the alarm: activate the nearest fire alarm and warn people who are at risk; call the fire and rescue services.
• Assessing for danger: if the fire is small, is discovered early and a fire blanket or appropriate fire extinguisher is available, try to smother the flames; if unable to extinguish the flames within 30 seconds leave the building.
• Getting to safety: leave the building and close doors behind you; do not enter a smoke-filled room; follow fire escape route if appropriate.

Some basic principles:

• Do not use an elevator – if the electricity fails the elevator may abruptly stop working; also the elevator shaft can act like a chimney, sucking up flames and fumes.
• If in a room full of smoke, remain close to the floor and if possible cover the nose and mouth with a damp cloth or towel.
• Close doors on a fire.
• Never open a door that is hot or has hot handles – suggests that a fire is raging behind it.
• If unable to find an escape route, locate a fire-free room that has a window; shut the door, open the window and call out for help and remain close to the floor; if possible block any gaps under the door.
• Even if it is dark, do not turn on the light as this may cause an explosion.

Source: Jevon (2004); St John Ambulance et al. (2011)

Removing the casualty’s clothing

Removing the casualty’s clothing can make him feel more anxious and vulnerable, so it is important only to remove the clothing if it is absolutely essential and do not forget to obtain the casualty’s consent, where possible, explaining to him why it is necessary to do so and always maintain his dignity.

If it is necessary to cut a garment, try to cut along the seams of trousers or sleeves (St John Ambulance et al., 2011) (easier to repair the clothing) and if the casualty has a foot or leg injury, try to remove the shoe or boot before the ankle/leg becomes swollen.

If removing an upper garment when there />